RT3340X half title 6/22/06 11: 41 am page 1 The Disability
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highlighting individuals’ power in relation to oppressive political and economic structures, Danquah’s narrative off ers a powerful antidote to despair. In order apprehend the signifi cance of Willow Weep for Me, a critical method that can account for intersections of multiple forms of oppression is crucial. “I am black; I am female; I am an immi- grant,” Danquah writes. “Every one of these labels plays an equally signifi cant part in my perception of myself and the world around me” (225). 3 Unfortunately, disability studies has been slow to theorize such intersectionality, particularly when it comes to race. While works like Bonnie G. Smith and Beth Hutchinson’s 2004 anthology, Gendering Disability, testify to a growing interest in exploring connec- tions between gender and disability, many of the most foundational works in disability studies have analyzed race and disability, not in tandem, but in opposition to each other. 4 In their eff orts to stake out a claim for disability as worthy of intellectual and political attention, disability scholars oft en represent the relationship between people with disabilities and other political minorities in hierarchical terms. 5
the eff ect of opposing the interests of disabled people and people of color. When Rosemarie Garland- Th omson characterizes disability as a “form of ethnicity,” or when Lennard J. Davis compares “the disabled fi gure” to “the body marked as diff erently pigmented,” it’s clear that neither intends to place race or ethnicity in opposition to disability; rather, they each seek to establish a likeness between two categories, and thus to gain recognition of disabled people as members of a political minority (Th omson,
6; Davis, EN, 80). But as Trina Grillo and Stephanie M. Wildman have argued, “like race” analogies oft en have the eff ect of “obscuring the importance of race,” enabling the group making the analogy to take “center stage from people of color” (621). Moreover, such analogies assume a false separation between the forms of oppression being compared. As Grillo and Wildman point out in their discussion of analogies between race and gender, “[a]nalogizing sex discrimination to race discrimination makes it seem that all the women are white and all the men are African-American”; thus, they observe, “the experience of women of color . . . is rendered invisible” (623). Th e dangers of “like race” analogies in disability studies are similar: if race and disability are conceived of as discrete categories to be com- pared, contrasted, or arranged in order of priority, it becomes impossible to think through complex intersections of racism and ableism in the lives of disabled people of color. 6 Th is is not, of course, to deny that analogies can be useful; I share Ellen Samuel’s sense that rather than attempting “somehow to escape from analogy,” we might “seek to employ it more critically than in the past” (4). Th ese intersections must be understood in ways that are more than merely additive, as Angela P. Harris argues in her critique of “gender essentialism—the notion that a unitary, ‘essential’ women’s experience can be isolated and described independently of race, class, sexual orientation, and other realities of experience” (585). According to an additive model of multiple oppressions, Harris argues, “black women will never be anything more than a crossroads between two kinds of domination, or at the bottom of a hierarchy of oppressions” (589). 7 I would therefore suggest that, in examining inter- sections of forms of oppression, we guard against the dangers of a “disability essentialism,” in which the experiences, needs, desires, and aims of all disabled people are assumed to be the same and those with “diff erent” experiences are accommodated only if they do not make claims that undermine the movement’s foundational arguments. Many of these arguments have been developed primarily with physical disability in mind. Cognitive and psychiatric impairments, although they are gaining more attention, nonetheless remain marginalized, both within disability studies and in the broader culture. I was recently reminded of the extent of this marginalization when I mentioned to a colleague that I was writing an essay on Black women and depression; she responded by asking, “Does depression count as a disability?” Her question is crucial. “Th e short answer,” I told my colleague, “is ‘yes’.” Th e longer answer would have involved a discussion of the ways in which truly “counting” the experiences of people with mental illness might necessitate revising some of disability studies’ most frequently cited claims. RT3340X_C023.indd 284 RT3340X_C023.indd 284 7/11/2006 10:09:00 AM 7/11/2006 10:09:00 AM 285 “When Black Women Start Going on Prozac . . .” While the necessity of such revisions becomes particularly evident when the politics of race, gender, and mental illness are analyzed together, the arguments that follow should not be taken as part of an unitary account of such intersections: I wish to be clear that I am not suggesting any intrinsic relation- ship among Blackness, femininity, and mental illness; nor do I propose to read Danquah’s memoir as representative of a monolithic “Black women’s perspective on depression.” 8 I do hope to show, however, that examining the converging eff ects of multiple forms of oppression can have profound implications for disability studies. Reading Willow Weep for Me with such eff ects in mind will require the rethinking of some of the fi eld’s most central tenets: its reluctance to understand disability in terms of sickness or suff ering, its tendency to defi ne disability in visual terms, and its resistance to stories of overcoming. If we avoid this critical reevaluation, we risk misreading as naïve or politically disengaged the work of Danquah and others whose perspectives diverge from disability studies’ entrenched ideas. Going on Prozac Among people with depression, the politics of mental illness are complex and highly contested. In particular, much controversy surrounds questions about whether people who experience emotional distress are sick. Th roughout her memoir, Danquah emphasizes that her depression is an “illness”; by doing so, she adopts a strategy that diverges from that of the psychiatric survivor movement (18). Members of this movement defi ne themselves as “survivors,” not of mental illness, but rather of in- stitutionalization in psychiatric hospitals. 9 Indeed, they oft en reject the very category of “mental ill- ness,” which they view as a largely meaningless invention of modern psychiatry that serves to enforce conformity to social norms and to derive money and power for mental health “experts.” Protesting doctors’ excessive control over the lives of people we diagnose as “mentally ill,” psychiatric survivors describe incarceration in mental institutions that are oft en run like prisons, as well as nonconsensual administration of “therapies” that resemble punishments or even torture. 10 Moreover, they note that psychiatrists themselves are unable to defi ne mental illness; that no biological or genetic cause of any putative mental disorder has ever been demonstrated; and that the most common treatments—psy- choactive medications, electroconvulsive therapy (ECT), seclusion, and physical restraints—have no proven benefi ts and cause debilitating side eff ects, including brain damage. 11 Survivors’ testimonies demonstrate the appalling extent to which the label of “mental illness” has been used to deprive people of autonomy, respect, and human rights. 12 What, then, do we make of Danquah’s defi nition of her depression as a “mental illness” (20)? In what context do we understand her emphasis upon the necessity of taking antidepressant medica- tion? “I have tried to deny my need for medication and stopped taking it,” Danquah explains. “Each time, at the slightest provocation, I have fallen, fast and hard, deeper into the depression” (220; 258). However, Danquah does not regard depression as purely a medical phenomenon. “Th e illness exists somewhere in that ghost space between consciousness and chemistry,” she writes (257–58). She takes her Paxil “reluctantly,” observing that “there is something that seems really wrong with the fact that Prozac is one of the most prescribed drugs in this country” (258). 13
health care, rather than involuntary imposition of it, is the most salient aspect of her interactions with the medical profession. Danquah sees adequate medical treatment for her depression as a necessity, to which poverty, racism, and gender bias have created almost insurmountable barriers. Her obstetrician dismisses one of her fi rst episodes of severe depression as the eff ect of “hormones” (36). Years later, she seeks treatment but has great diffi culty locating a mental health clinic she can aff ord. Danquah is able to pay for only one of the medications she is prescribed, Zoloft , an antidepressant. Anxiety is a side eff ect of Zoloft , so her doctor writes her a prescription for BuSpar, an anxiety controllant. Th is drug, however, is prohibitively expensive, so Danquah resorts to alcohol to manage the side eff ects of her antidepressant. Indeed, the Zoloft seems to cause an insatiable craving for alcohol, which disappears RT3340X_C023.indd 285 RT3340X_C023.indd 285 7/11/2006 10:09:01 AM 7/11/2006 10:09:01 AM
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when she discontinues the medication (221). Danquah is forced to fi gure most of this out without any medical supervision. Most of the practitioners at the mental health clinic she goes to are therapists-in- training, and hers leaves abruptly once she has completed her certifi cation process. Rather than being “reassigned” at random to another therapist, Danquah suspends psychotherapy (208). In addition to economic obstacles, Danquah faces cultural barriers to appropriate health care. Her psychiatrist, Dr. Fitzgerald, is a white man who describes at length his inability to “even fathom” the racism with which she routinely copes (224). Experiences like this are commonplace for African American women seeking mental health care. Julia A. Boyd, an African American psychotherapist, observes that many white mental health practitioners “remain in a passive state of denial concerning the therapeutic needs of black women” (“Ethnic,” 232). In addition, people of color, especially African Americans, are less likely to be diagnosed with depression or prescribed medication when they report their symptoms to a doctor; even in studies controlling for income level and health insurance status, the disparities are great. 14 Th e contrast between Danquah’s experience and that of many members of the psychiatric survi- vor movement highlights a conundrum facing people with depression or other mental illnesses. Th e enormous power that the psychiatric profession wields in modern Western societies creates a double bind, in which both diagnosis with a mental illness or, alternatively, the lack of such a diagnosis, brings with it serious negative social consequences for people experiencing emotional distress. 15 Being
diagnosed with a mental illness means risking social stigmatization, involuntary institutionalization, and treatment with dangerous medications. On the other hand, those who are not deemed truly mentally ill are oft en regarded as merely malingering. Depression, Danquah observes, is “not looked upon as a legitimate illness. Most employers really don’t give a damn if you’re depressed, and neither do landlords or bill collectors” (144). Th is lack of social validation and support is exacerbated by racism. Th e symptoms of depression, Boyd points out, oft en “mirror the stereotypes that have been projected onto Black women”; before she was diagnosed with the disorder herself, Boyd thought that “being depressed meant that you were crazy, lazy, unmotivated” (8; 15). Moreover, as Danquah notes, depression is “still viewed as a predominantly ‘white’ illness”; when Black people become depressed, the symptoms and coping strategies usually go unrecognized (184). 16 Pervasive social denial and lack of access to necessary medical care are the political realities that Danquah highlights in her account of her struggles with depression. While these realities are inextricable from the politics of race, I do not wish to suggest that all Black women with depression share Danquah’s perspective on the medicalization of emotional distress. 17
In addition, it is important to remember that the other aspect of the double bind I have described— i.e., diagnosis of a mental illness as the justifi cation for involuntary confi nement and forcible “treat- ment”—also carries additional risks for Black people. While white people are more oft en diagnosed with depression and prescribed antidepressants, African Americans are diagnosed with schizophrenia at much higher rates and are also given antipsychotic medications more frequently and in higher doses. Th ey are also more oft en institutionalized involuntarily, in part because racial stereotypes aff ect psychiatrists’ assessments of their “dangerousness.” 18 Th
e pathologization of Black people is also built into what Danquah terms “the oppressive nature of the existing language surrounding depression,” the commonplace metaphors of depression as darkness and blackness (21–22). 19
Danquah’s critique of the politics of race and mental illness exposes and protests linguistic, social, cultural, and economic barriers that impede Black women with depression from accessing health care. In contrast to the psychiatric survivor movement, her primary focus is on this lack of access, rather than the eff ects of involuntary treatment. But she shares with psychiatric survivors a profound sense of the importance of self-determination and control over one’s own medical treatment. Dan- quah begins to see signifi cant improvement in her depression when, as she puts it, “I took control of my own healing” (225). Recognizing that her own role in her treatment is more important than that of her psychiatrist, she realizes, “it did not make that much of a diff erence to me if Dr. Fitzgerald was listening or not, if he cared or not, if he understood or not. I was listening. I was hearing. I was understanding. I cared” (225–26). RT3340X_C023.indd 286 RT3340X_C023.indd 286 7/11/2006 10:09:01 AM 7/11/2006 10:09:01 AM 287 “When Black Women Start Going on Prozac . . .” Disability or Impairment?: Depression and the Social Model Danquah’s understanding of her depression as a “disease” not only adds another dimension to the psychiatric survivor movement’s critique of the mental health profession, but also complicates what has come to be known as the “social model” of disability. Th e social model was developed in Britain in the 1970s; a key moment in its emergence occurred in 1976, when the Union of the Physically Impaired Against Segregation (UPIAS) published its Fundamental Principles of Disability. Perhaps the most important of these “fundamental principles” was the crucial distinction the document made between “impairment” and “disability”: In our view it is society which disables physically impaired people. Disability is something imposed on top of our impairments, by the way we are unnecessarily isolated and excluded from full participa- tion in society . . . (3) UPIAS’s diff erentiation between the bodily (impairment) and the social (disability) formed the basis of what Mike Oliver subsequently presented as the “social model of disability.” 20 Th
e social model, like the minority group model that emerged in the United States, has enabled major transformations in the conceptualization of disability; rather than accepting traditional defi nitions of disability as a personal misfortune, this new paradigm frames disability in terms of social oppression. What the social model may sacrifi ce, however, is a way of thinking in political terms about the suff ering that some impairments cause. As Liz Crow points out, the social model sometimes has the eff ect of obscuring the reality that “[P]ain, fatigue, depression and chronic illness are constant facts of life” for many people with disabilities (58). Th is problem is pervasive not only in applications of Britain’s social model, but also in disability studies in the United States, where the “critique of the medical model” is a fundamental principle. Critiquing the medical model does not necessarily preclude recognition of chronic and terminal illnesses as disabling forms of impairment. However, in practice this critique oft en functions to diff erentiate people with disabilities from those who are ill. 21 Argu- ing for greater inclusion of people with chronic illness in the disability community, Susan Wendell takes issue with Eli Clare’s contention that people with disabilities should not be regarded as “sick, diseased, ill people” hoping to be cured (Wendell 18; Clare 105). As Wendell points out, “some people with disabilities are sick, diseased, and ill”; moreover, she observes, some disabled people “very much want” to be cured (18). Danquah expresses this wish at the end of her memoir: “I choose to believe that somewhere, somehow, there is a cure for depression” (257). If the experiences of those who defi ne themselves as ill and hope to be cured are elided in much disability scholarship, this may be due in part to the fi eld’s emphasis on visible aspects of disability. Garland-Th omson’s defi nition of disability as a process that emerges through “a complex relation between seer and seen” is of great value in thinking about the “extraordinary bodies” she discusses, but the framing of disability in terms of outward appearance is less useful for analyzing depression and other invisible impairments, particularly those that involve sickness and suff ering (136). Simi- larly, Harlan Hahn’s positing of a “correlation between the visibility of disabilities and the amount of discrimination which they might elicit” has little to do with Danquah’ experience.” 22 Danquah loses friends and jobs precisely because her disability is not visible and therefore is not recognized as a “legitimate illness” (144; 30). Indeed, disability studies’ emphasis upon observable manifestations of impairments makes it dif- fi cult to know how to begin thinking about a condition like depression, which is primarily a subjective experience. Moreover, it is an experience characterized by suff ering: “Suff ering . . . was what depres- sion was all about,” Danquah refl ects (237). 23 Th
e issue of suff ering has been vexed within disability studies. As Bill Hughes and Kevin Paterson observe, “Disabled people . . . feel uncomfortable with the concept of suff ering because . . . it seems inextricably bound to a personal tragedy model of disability” (336). As Oliver states, “the social model is not about the personal experience of impairment but the collective experience of disablement” (“Social,” 22). However, the strategy of maintaining a focus on RT3340X_C023.indd 287 RT3340X_C023.indd 287 7/11/2006 10:09:01 AM 7/11/2006 10:09:01 AM
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social oppression rather than personal suff ering—or on “disability” as opposed to “impairment”—risks reifying a dichotomy that does not easily apply to disorders like depression. While impairments ranging from cerebral palsy to blindness, spinal cord injury, or autism do not always cause suff ering in and of themselves, it makes little sense for a person to say she is clinically depressed but does not suff er. And whereas it’s illuminating, when discussing the politics surrounding mobility impairments, to observe that disability results from inaccessible architectural structures rather than from bodily defi ciency, it’s diffi cult to use this paradigm to understand depression. It is true that, to a certain extent, one could apply the impairment-disability distinction to Danquah’s experience. Arguably, Danquah’s impairment, depression, becomes disabling because of a societal unwillingness to accommodate it: “I lost my job because the temp agencies where I was registered could no longer tolerate my lengthy absences,” she recounts (30). “I lost my friends. Most of them found it too troublesome to deal with my sudden moodiness and passivity” (30). Th ese social pressures correspond to UPIAS’s defi nition of “disability” as “something imposed on top of our impairments” (3). But an analysis of Danquah’s text that privileges “the collective experience” of disability over “the personal experience” of impairment would greatly distort her account of her struggles with depres- sion (Oliver, 22). A lack of social validation or understanding, although a persistent facet of her experience, seems to recede into the background of the intense and prolonged suff ering in which her depression immerses her. Th roughout Willow Weep for Me, Danquah describes this suff ering in vivid and oft en metaphorical language, which contrasts with her matter-of-fact reports of lost friends and career opportunities. She writes that her life “disintegrated; fi rst, into a strange and terrifying space of sadness and then, into a cobweb of fatigue” (27). She describes “nails of despair . . . digging . . . deeply into my skin” and “a dense cloud of melancholy [that] hung over my head” (30). As her depression worsens, she writes, “It seemed as if the world was closing in on me, squeezing me dry” (32). She remembers “absolute terror” and “despair [that] cut so deeply, I thought it would slice me in half ” (42; 106). As such stark descriptions of suff ering make clear, relegating “impairment” to a secondary status within an impairment-disability binary elides the phenomenological aspects of depression as a state of suff ering. Moreover, analyses that privilege disability over impairment defl ect attention from the political nature of impairment itself. In Danquah’s narrative, the social environment is important less for its imposition of an additional burden “on top of ” a pre-existing impairment than for its role in produc- ing her depression (UPIAS, 3). When Danquah is a child, her schoolmates ostracize her, mocking her accent and calling her “the African Monkey” (104). She recalls that the “host of . . . horrid epithets” to which she was subjected “shattered any personal pride I felt and replaced it with uncertainty and self-hatred” (105). When her father abandons the family, Danquah begins to think of herself as “the ugly little girl, the ‘monkey,’ the fatherless child” (109). In junior high, she is raped by a recent high school graduate she has a crush on (120). When she confi des in her stepfather about the incident, he rapes her, too; the sexual abuse continues throughout her adolescence (124). As a young adult, un- diagnosed postpartum depression coupled with physical abuse by the father of her child contribute to an episode of serious depression. A subsequent episode is triggered by the “not guilty” verdict in the Rodney King trial: “We, all black people, had just been told that our lives were of no value,” Danquah remembers (42). Distress or Disease?: Deconstructing the Social Model As Danquah’s story illustrates, the oppression of disabled people is not merely “something imposed on top of ” a pre-existing impairment; rather, the production of some impairments is itself a politi- cal process (UPIAS, 3). Th erefore, Willow Weep for Me might at fi rst seem to accord with the argu- ments of some disability scholars who, deconstructing the impairment-disability binary, claim that impairment is a discursive production. 24 Shelley Tremain argues that a Foucaultian analysis will RT3340X_C023.indd 288 RT3340X_C023.indd 288 7/11/2006 10:09:01 AM 7/11/2006 10:09:01 AM 289 “When Black Women Start Going on Prozac . . .” reveal “that impairment and its materiality are naturalized eff ects of disciplinary knowledge/power” (SI, 34). Locating the origins of modern-day categorizations of bodies as normal or impaired in the nineteenth-century bio-medical discourses whose genealogies Foucault traces, Tremain observes that impairment is neither a “‘prediscursive’ antecedent” nor a set of “essential, biological characteristics of a ‘real’ body” (SI, 42). Indeed, Tremain’s theorization of impairment is à propos to any discussion of depression, whose constructedness as a disease entity is easily apparent. While the term “melancholy” is as old as ancient Greek medicine, its defi ning features have been broad and shift ing, never corresponding to the pres- ent-day disease category of “clinical depression.” Th e instability of depression as a discrete medical phenomenon is further evident in the extent to which those who wish to establish it as such must continually defi ne it by diff erentiating it from ordinary states of sadness. “Depression isn’t the same as ordinary sadness, it is hell,” Danquah’s friend Scott says (260). Or, as Danquah explains, “We have all, to some degree, experienced days of depression . . . But for some, such as myself, the depression doesn’t lift at the end of the day . . . And when depression reaches clinical proportions, it is truly an illness” (18). 25
diabetes, cancer, or rheumatoid arthritis, skeptics abound when it comes to depression. Eboni, one of several African American woman with whom Boyd engages in a dialogue about depression, says, “look at what our mothers and grandmothers went through in their lives and we don’t hear them whining about depression” (CI, 21). Eboni’s comments not only underscore the constructedness of depression as a clinical entity, but also raise another set of questions. While it’s relatively easy to observe that depression cannot be regarded as a prediscursive bodily or mental “given,” what remains unclear are the possible eff ects of the processes by which it is currently being consolidated as a defi nable and describable disease. For example, does the construction of depression as an illness enable a potentially emancipatory reinterpretation of behaviors traditionally regarded as moral weakness, such as the “whining” that Eboni dismisses? It is in part to distinguish depression from “a character fl aw” that Danquah insists that depression “is truly an illness” (18). But Tremain’s analysis of the constructed- ness of impairments raises the possibility that Danquah’s self-construction as a “depressive” might have “insidious” eff ects (Danquah, 18; Tremain, SI, 37). Reliance on biomedicine’s constructions of bodily and mental diff erence, Tremain argues, may only further consolidate the pervasive power of disciplinary regimes (SI, 42). Tremain’s characterization of impairments as discursively produced is cogent and insightful. However, as I will argue, Willow Weep for Me demonstrates that impairment categories can be cited in ways that, rather than merely “meet[ing] requirements of contemporary political arrangements,” instead also serve to undermine them (Tremain, SI, 42; FG, 10). To elucidate this process, it will be helpful to refl ect upon the epistemic shift that Foucault and other historians have documented in late eighteenth- and early nineteenth-century medicine. With the rise of clinical medicine in the nineteenth century, the physical examination and the dissection of corpses supplanted patients’ stories as the privileged modes of generating medical knowledge. 26 Th e dominant medical epistemology became visual rather than narrative: the patient came to be seen as a passive body, manifesting visible signs of disease which could be interpreted by the doctor’s detached “gaze.” 27 Th ese visible “signs,” or objective manifestations of disease, were privileged over “symptoms,” which referred to subjective sensations the patient reported (Porter, 313). Th e sign-symptom binary remains a centerpiece of contemporary medical epistemology, and its continued importance helps explain why depression has not been re- garded as a “real” disease in the same way as illnesses such as arthritis or multiple sclerosis, which can be visualized on X-rays or MRIs. Whereas the careful observation of bodily changes, the dissection of cadavers, and eventually the emerging science of bacteriology enabled nineteenth-century physicians to defi ne diseases like tuberculosis as distinct clinical entities, the same cannot be said of depression. Indeed, the project of solidifying depression as a bona fi de medical condition is grounded in the expectation that it will one day be possible to identify specifi c biological markers of the disorder and thus to demonstrate that depression is an organic disease of the brain. RT3340X_C023.indd 289 RT3340X_C023.indd 289 7/11/2006 10:09:02 AM 7/11/2006 10:09:02 AM Anna Mollow 290
Because such signs remain elusive, the construction of depression as a disease is presently occur- ring in ways that diff er signifi cantly from the discursive materialization of most of the impairments that receive attention in disability studies; that is, from most visible impairments. 28 Western medicine has obtained signifi cant knowledge about impairments such as cataracts, colitis, and heart disease, all of which manifest visible signs, without much active participation on the part of the patient; but a depressed person, to be understood as such, must be a subject who communicates. 29 Moreover, he or she must have a degree of psychological depth that a patient being examined for signs of a physi- cal ailment need not be recognized as possessing. Instead of simply reporting a pain or displaying a rash, a fever, or a tremor, the depressed patient is most oft en subjectivized as such through the production of a narrative. 30 It is perhaps for this reason that, as Danquah observes, our culture is so reluctant to recognize depression in Black women. It is “hard,” she remarks, “for black women to be seen as . . . emotionally complex” (21). Yet it would certainly be a mistake to romanticize medicine’s inclusion of subjects’ accounts of their distress in its process of consolidating depression as a disease entity. Th e incorporation of pa- tients’ stories into medical discourses on depression or other forms of “mental illness” is shaped by a profound power imbalance between doctors and patients. While a diagnosis of depression is rarely made without the participation of the patient as a speaking subject, once one is labeled “mentally ill,” one is oft en treated as less than a full subject, denied the right to choose a course of treatment or decline medical intervention altogether. 31 Moreover, as Anne Wilson and Peter Beresford point out, patients defi ned as “mentally ill” have little control over the ways in which their words are presented and interpreted in their medical records. Wilson and Beresford, who are themselves psychiatric system survivors, recall that “it can feel as if everything you say or do is being taken down and recorded to be used in evidence against you” (148). In addition, they point out, “as medical records are ineradicable, they also serve to make permanent and immutable the ostensible psychopathological diff erence or ‘disorder’ of those diagnosed ‘mentally ill’” (149). Th is power imbalance between doctors and “mentally ill” subjects exerts itself in more subtle ways as well. Wilson and Beresford relate that “it can be diffi cult even to begin to make sense of our experience outside of frameworks provided by ‘experts,’ whose theories and powers may extend to every aspect of our lives, not least our identity as ‘mentally ill’ (non-)persons” (145). Th is observation seems to illustrate Foucault’s claim that the “individual is an eff ect of power” (TL, 98). And indeed, Foucault’s arguments about subject formation raise questions about the relation of Danquah’s narra- tive to dominant psychiatric discourses. Does Danquah, by defi ning herself as a “depressive,” merely reinscribe the dictates of psychiatric medicine (18)? According to Tremain, “a Foucauldian approach to disability” shows that “the category of impairment . . . in part persists in order to legitimize the disciplin- ary regime that generated it” (FG,11; SI, 43). Tremain does not explore the possibility, however, that the production of specifi c impairment categories might have multiple, competing eff ects, including, paradoxically, the contestation of the assumptions on which these categories are based. Such a contestation takes shape in Danquah’s autopathography, which depends upon biomedicine’s construction of depression as a disease entity but at the same time resists the normalizing eff ects of this construction. Danquah articulates her resistance to the disciplinary uses of depression as a medi- cal category in ways that Foucault’s concept of a “reverse discourse” can illuminate. Foucault argues that the nineteenth-century emergence of psychiatric and other discourses that brought into being “the homosexual”as a “species” had the eff ect, not only of enabling “a strong advance of social con- trols into this area of ‘perversity,’” but also of making “possible the formation of a ‘reverse’ discourse: homosexuality began to speak on its own behalf, to demand that its legitimacy . . . be acknowledged, oft en in the same vocabulary, using the same categories by which it was medically disqualifi ed” (HS, 101–02). Danquah’s narrative might be understood as participating in a “reverse discourse” regarding depression. As we have seen, it employs the categories of psychiatric medicine in order to demand that depression’s “legitimacy . . . be acknowledged” (HS, 101). Depression, Danquah maintains, is “a legitimate illness”; she is not “a fl ake or a fraud” (144). 32
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291 “When Black Women Start Going on Prozac . . .” Additionally, at the same time that she emphasizes that depression is an authentic medical condi- tion, Danquah also subverts some of psychiatry’s most fundamental assumptions about what it means to be mentally ill. If today’s “depressive” is “disqualifi ed” in ways analogous to the disqualifi cation of Foucault’s nineteenth-century “homosexual,” Danquah’s narrative perhaps mobilizes a reverse discourse that resists this disqualifi cation while nonetheless retaining the vocabulary and diagnostic categories that enable it. Th is can be seen in Danquah’s emphasis on the imbrication of her illness with political oppression. A common mode of discrediting people with depression eff ects a discursive separation of symptoms from politics: depression is said to arise from feelings, beliefs, and attitudes which are disproportionately “negative” in relation to the affl icted person’s actual circumstances. 33 Indeed, this is Eboni’s critique of psychiatric constructions of depression: “I didn’t hear where any of those big-time researchers were lookin’ at things like racism or sexism,” she points out (21). But this, of course, is exactly what Danquah does look at. By showing how the convergence of racism, sexual violence, and poverty literally made her ill, Danquah insists upon the validity of depression as a diagnostic category while at the same time contesting hegemonic accounts of its etiology. Moreover, even as Danquah accepts the designation of her emotional distress as a “disease,” she also undermines one of psychiatric medicine’s most fundamental claims (18). As Wilson and Beresford point out, psychiatry’s justifi cation as an institution relies in large part upon “its construction of users of mental health services as Other—a separate and distinct group” (144). Interestingly, however, Danquah’s gradual process of accepting that she is ill and needs medical treatment paradoxically culminates in her deconstruction of the normal/mentally ill binary upon which psychiatry’s authority depends: I had always only thought of therapy in stark, clinical terms: an old bespectacled grey-haired white man with a couch in his offi ce listening to the confessions of crazies. . . . What if, I asked myself, those “crazies” are no diff erent than me? What if they are like me, ordinary people leading ordinary lives who woke up one day and discovered they couldn’t get out of bed, no matter how much they wanted to or how hard they tried? (167–68) Danquah decides to enter psychotherapy, then, not because she comes to defi ne herself as “Other,” but because she is able to imagine the dissolution of what Wilson and Beresford call psychiatry’s “op- position between ‘the mad’ and ‘the not-mad’” (154). Indeed, her sense that the depressive is not a distinct species, but rather a member of a community of “ordinary people,” fi nds echo in Wilson and Beresford’s assertion that “the world does not consist of ‘normals’ and ‘the mentally ill’; it consists of people” (Danquah 167–68; Beresford and Wilson, 144). Like the arguments of critics who use Foucaultian paradigms to analyze disability, Danquah’s work demands a deconstruction of the impairment-disability distinction, forcing a theorization of impair- ment as itself a social process. Yet Danquah nonetheless accepts the category of mental illness and makes it integral to her self-conception. For this reason, an application of Tremain’s or Wilson and Beresford’s analyses of the constructedness of impairment categories might seem to authorize a reading of Danquah’s narrative as “naïve,” unaware of how the category of impairment operates within what Tremain, following Foucault, calls the “insidious” production of “an ever-expanding and increasingly totalizing web of social control” (SI, 34; 37; FG, 6). 34 But as we have seen, Foucault’s understanding of power is more fl exible than Tremain’s characterization of it here suggests. 35 Rather than “a general system of domination” whose “eff ects . . . pervade the entire social body,” Foucault describes a “mul- tiple and mobile fi eld of force relations, wherein far-reaching, but never completely stable eff ects of domination are produced” (HS, 92; 101–02; emphasis mine). “Discourse,” he explains, “reinforces” power “but also undermines and exposes it” (HS, 101). Foucault’s conception of discourse as reversible points to the possibility that individuals might invoke discursive constructions such as “depression” so as to do more than merely, as Tremain puts it, “identify themselves in ways that make them governable” (SI, 37; FG, 6). It is true that, as David Halperin remarks, Foucault is critical “of discursive reversal . . . as a political strategy” in contemporary Western societies (58). Nevertheless, for Foucault a “reverse discourse” can constitute “a signifi cant RT3340X_C023.indd 291 RT3340X_C023.indd 291 7/11/2006 10:09:02 AM 7/11/2006 10:09:02 AM
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act of political resistance”; it is by no means “one and the same as the discourse it reverses” (Halperin, 59). Foucault explains that although reverse discourses and other forms of resistance cannot be del- ployed “outside” of power, “this does not mean that they are only a reaction or rebound . . . doomed to perpetual defeat” (HS, 95; 96). Tremain accurately observes that the institutionalization of reverse discourses as identity politics movements poses signifi cant dangers. 36 However, I wish to challenge what seems in her argument to be a global suspicion of any and all processes of “iteration and reiteration of regulatory norms and ideals about human function and structure, competency, intelligence and ability” (SI, 42). Th is suspicion seems to derive in part from Tremain’s mapping of Judith Butler’s deconstruction of the sex-gender binary onto the social model’s distinction between impairment and disability (SI, 38–41). But the “reiteration” that Tremain regards as functioning to “sustain, and even augment, current social arrangements,” is precisely the process in which Butler fi nds potential for revision of cultural norms and identity categories (SI, 42). Butler argues that “‘sex’” is materialized “through a forcible reiteration” of “regulatory norms”; however, this process produces “instabilities” and “possibilities for rematerialization,” in which “the force of the regulatory law can be turned against itself ” (4). Th is turning of the regulatory law against itself, Butler suggests, might be achieved through what she calls a “citational politics,” which entails a “reworking of abjection into political agency” (21). Butler’s discussion of “citational politics” focuses primarily upon instances in which “the public assertion of queerness” has the eff ect of “resignifying the abjection of homosexuality into defi ance and legitimacy” (21). Although Danquah does not treat race, gender, or mental illness in ways that correspond exactly to Butler’s description of queerness as performativity, one can nonetheless discern in Willow Weep for Me a “reworking of abjection into political agency” (Butler, 21). 37 Th
roughout her memoir, Danquah foregrounds abjection in the form of “weakness” (20). She observes that although mental illness is oft en regarded as a sign of “genius” in white men, of hysteria in white women, and of pathology in Black men, “when a black woman suff ers from a mental disorder, the overwhelming opinion is that she is weak. And weakness in black women is intolerable” (20). It is perhaps also unthinkable: “Clinical depression simply did not exist . . . within the realm of pos- sibilities for any of the black women in my world,” Danquah explains (18–19). “Emotional hardship is supposed to be built into the structure of our lives” (19). Indeed, when Danquah tells a white woman she meets at a dinner party that she’s writing a book on Black women and depression, the woman responds sarcastically: “Black women and depression? Isn’t that kinda redundant? . . . [W]hen black women start going on Prozac, you know the whole world is falling apart” (19–20). Th e foreclosure of depression as a possible diagnosis for Black women, Danquah argues, derives from the “myth” of Black women’s “supposed birthright to strength” (19). “Black women are supposed to be strong—caretakers, nurturers, healers of other people—any of the twelve dozen variations of Mammy (19). 38
By linking the image of the strong Black woman to the stereotype of the “mammy,” Danquah points to the history of slavery in the United States as one of its possible origins. As Patricia Hill Collins ob- serves, the fi gure of the “mammy,” or the “faithful, obedient domestic servant,” was invented in order to “justify the economic exploitation of house slaves” (71). Danquah’s contestation of the ideal of an inherently strong Black womanhood thus resists the social demand that Black women deny their own emotional and material needs in order to attend to those of others. 39 As Evelyn C. White writes, “the vulnerability exposed in Willow Weep for Me . . . will do much to transform society’s image of Black women as sturdy bridges to everyone’s healing except their own” (Danquah NP). Paradoxically, while the notion that Black women are uniquely equipped to endure hardship has historically served as a justifi cation for their oppression, it may also have enabled their survival. “Given the history of black women in this country,” Danquah argues, “one can easily understand how this pretense of strength was at one time necessary for survival” (NP). Th e belief that strength is a legacy of slavery persists in Black communities, Danquah remarks, pointing out that it is not only white people who dismiss Black women’s depression. “If our people could make it through slavery, we can make it through anything,” Black men and women have told Danquah (21). But what this “stereotypic RT3340X_C023.indd 292 RT3340X_C023.indd 292 7/11/2006 10:09:02 AM 7/11/2006 10:09:02 AM 293 “When Black Women Start Going on Prozac . . .” image of strength . . . requires” of Black women, Danquah emphasizes, “is not really strength at all. It is stoicism. It is denial. It is a complete negation of their pain” (NP). 40
atic—“part of the package,” as Danquah puts it—rather than symptomatic of a condition in need of a remedy, Danquah’s pathologization of her distress cannot be seen as merely an accession to the social norms upon which the category of “mental illness” depends; rather, by defi ning her suff ering as sickness, Danquah transgresses the expectation that when Black women suff er, they do so silently and stoically (19). Refusing any denial of her pain, Danquah unfl inchingly describes the shame and self-loathing that are both symptoms and sources of her depression. She relates that amid a severe episode of depression she stopped bathing and cleaning her house, leaving “a trail of undergarments and other articles of clothing” on the fl oor, “dishes with decaying food” on “every counter and tabletop” (28). She recalls feeling “truly pitiful,” “hating myself so much I wanted to die” (219; 106). “Something had gone wrong with me,” she realizes (29). Th is conclusion may seem at odds with one of the central messages of the disability rights move- ment. Oliver’s critique of the medical model on the grounds that it “tends to regard disabled people as ‘having something wrong with them’ and hence [being] the source of the problem” is a tenet of disability studies (“Social,” 20). And while I certainly do not wish to reinstall hegemonic constructions of disability as a form of individual weakness or inferiority, I would suggest that in Danquah’s narrative it’s more complicated than a simple opposition between an individual and a social problem. Rather than imagining a wall of immunity between self and society, Danquah dramatizes the impossibility of ever remaining untouched by all that is wrong in the world (29). And her recognition that something has “gone wrong” with her is neither an indictment of herself as “the source of the problem” nor a cause of shame; instead, it is the impetus for her decision to make “a commitment to being alive” (Oliver, 20; Danquah, 230). Th is commitment requires a valuing of herself that contrasts sharply with the “stereotypic image of strength” with which “African American women who are battling depression must, unfortunately, contend” (Danquah NP). Th e strength that Danquah displays—and it would be impossible to come away from her book without feeling the magnitude of that strength—is neither endurance nor self- sacrifi ce; rather, it is what Danquah describes as a readiness “to claim the life that I want” (266). Shall We Overcome? Danquah’s memoir about depression ends on a hopeful note. “Having lived with the pain,” she writes, “I know now that when you pass through it, there is beauty on the other side” (266). Indeed, as her book’s subtitle indicates, hers is a “Black woman’s journey through depression” (emphasis mine). As such, Willow Weep for Me could be read as a story of overcoming. Th e blurb on the back cover of the paperback edition promises “an inspirational story of healing,” and Danquah herself employs many of the linguistic conventions associated with overcoming narratives. It takes “courage, devotion, and resilience” to “contend with depression” and to “triumph” over the illness, she writes (262). Such an emphasis on individual strength is at the crux of what many disability scholars critique in narratives of overcoming. As Simi Linton argues, “the ideas embedded in the overcoming rhetoric are of personal triumph over a personal condition,” rather than a collective demand for “social change” (18). Th ere is
enormous value in this observation, and I wholeheartedly concur with Linton’s objections to represen- tations of disability that make “the individual’s responsibility for her or his own success . . . paramount” (19). But as we have seen, the opposition between disability as personal misfortune and as social problem is not tenable in Danquah’s autopathography, which understands depression as inextricably both of these things. And if despair is both a cause and a symptom of depression, then perhaps part of its solution is a hope that is both personal and political. 41 As Danquah explains, “Th e social and economic realities of women, blacks, single parents, or any combination of the three” make “my RT3340X_C023.indd 293 RT3340X_C023.indd 293 7/11/2006 10:09:03 AM 7/11/2006 10:09:03 AM Anna Mollow 294
chances for a life that is free of depression appear to be slim . . .While I recognize the importance of such information, I regard most of the data as blather and refuse to embrace it” (257). Th is refusal is not a denial of political realities; rather, it is an unwillingness to accept defeat, an assertion of personal strength amid overwhelming social oppression. As Danquah puts it, it is a “standing up in defi ance of those things which had kept me silent and suff ering to say that I, an African American woman, have made this journey through depression” (NP). Notes
I would like to thank Richard Ingram, Robert McRuer, and Sue Schweik for their feedback on earlier versions of this essay. 1. See Garland-Th omson 135–37; Linton 17–19; and Mitchell and Snyder 9–11. See also note 21 below. 2. Lack of access to health care is tied to the politics of both race and class. Cultural, linguistic, and geographical barriers, as well as racist stereotypes, present specifi c impediments for African American, Latino/a, Asian American, and Na- tive American people seeking medical treatment for depression, regardless of income level and health insurance status (“Mental”). Access to health care has received less attention in disability studies than in the disability rights movement, where it has oft en been the focus of organizing. 3. Born in Ghana, Danquah emigrates to the United States when she is six years old (103). Although being an immigrant is of great importance to Danquah’s self-defi nition, this aspect of her identity receives far less attention in her memoir than race, gender, class, or mental illness. 4. A special issue of GLQ, Desiring Disability: Queer Th eory Meets Disability Studies (2003), edited by Robert McRuer and Abby Wilkerson, is devoted to the topic of queerness and disability. 5. In the introduction to Th e Body and Physical Diff erence, David T. Mitchell and Sharon L. Snyder write that “while liter- ary and cultural studies have resurrected social identities such as gender, sexuality, class, and race from . . . obscurity and neglect . . . disability has suff ered a distinctly diff erent disciplinary fate” (1–2). Barnes and Mercer draw a “sharp contrast” between the reception of disability studies in academia and that of “radical analyses of racism and sexism that quickly won favor” (IS, 4). Recently, leading disability scholars and activists have made similar comparisons between race and disability in their discussions of Clint Eastwood’s 2005 fi lm, Million Dollar Baby (Drake and Johnson, 1; Davis “Why,” 2;). And the chairman of Britain’s Disability Rights Commission, Bert Massie, recently stated that “neglect and institutional- ized exclusion” of disabled people is “more profound” than that of Black people (“Massie,” 1). 6. Samuels’s suggestion is part of her extended analysis of the dynamics of “passing” and “coming out” for queer people, racial minorities, and people with disabilities. For critiques of the “like race” analogy in queer theory and activism, see Janet E. Halley and Janet R. Jakobsen. 7. For critiques of additive models of racism and sexism, see Barbara Smith and Elizabeth Spelman. An example of an additive representation of intersectionality in disability studies is Davis’s assertion that “the most oppressed person in the world is a disabled female, Th ird World, homosexual, woman of color” (BOB, 29). Th is formulation, while a useful beginning, leaves untheorized the specifi c ways in which various forms of oppression come together in individual lives. 8. Th e Surgeon General reports that “the prevalence of mental disorders for racial and ethnic minorities in the United States is similar to that for whites.” Th ese statistics, however, apply only to those “living in the community”; people who are “homeless, incarcerated, or institutionalized” have higher rates of all forms of mental illness (“Mental” 1). According to the American Psychological Association, women are twice as likely as men to suff er from depression; the reasons for this discrepancy remain controversial (“New,” 1). 9. Information about the psychiatric survivor movement can be found at the Mind Freedom Support Coalition International Web site: http://www.mindfreedom.org/ 10. Courts have long recognized that patients with physical illnesses or disabilities have the right to refuse medical treatment. Th is constitutional protection, however, has oft en been denied to people diagnosed with mental illness, who can be com- mitted to mental institutions and treated involuntarily with toxic drugs and other potentially harmful therapies. In many states, involuntary outpatient treatment is also authorized by the courts. For more on this, see Jackson and Winick. 11. Th e side eff ects of ECT can be severe and permanent, as can those of neuroleptics, the medications most commonly prescribed for schizophrenia and other “psychotic” illnesses. Th e chemical eff ects of neuroleptic drugs are similar to those produced by lobotomies (Breggin, TP, 68–91). 12. Jeanine Grobe aptly compares the most common modern-day psychiatric practices to medieval treatments for “insanity”: “[M]ore oft en than not, [contemporary psychiatric] “medicine” is a complete atrocity—comparable only to the history out of which it grew: is four-point restraint—being tied down at the wrists and ankles—an improvement over being bound with chains? Is the cage inhumane whereas the seclusion room is not? Are the deaths that result from the use of neuroleptic drugs better than the deaths that resulted from bloodletting? Is the terror inspired by the passing of electric current through the brain an improvement over the shock of being submerged in ice water?” (103). 13. Th
e back of Willow Weep for Me includes the transcript of an interview of Danquah by Dr. Freda C. Lewis-Hall, director of the Lilly Center for Women’s Health, which is part of Eli Lilly, the pharmaceutical company that manufactures Prozac. RT3340X_C023.indd 294 RT3340X_C023.indd 294 7/11/2006 10:09:03 AM 7/11/2006 10:09:03 AM 295 “When Black Women Start Going on Prozac . . .” Danquah has also given book tours in conjunction with the National Mental Health Association’s Campaign on Clinical Depression, which is funded by Eli Lilly (http://www.psych.org/pnews/98-05-15/nmha.html). Th is may raise concerns about bias in Danquah’s representations of the benefi ts of psychoactive medications. However, Willow Weep for Me can hardly be said to read like an advertisement for antidepressants. As noted, Danquah expresses concern about their widespread use. In addition, she details the debilitating side eff ects she experienced from taking Zoloft . Most important, Danquah’s memoir certainly does not understand depression as simply a biological illness that can be cured with drug therapy. If, as she claims, depression “exists somewhere in that ghost space between consciousness and chemistry,” her interest in the former greatly exceeds her attention to the latter; describing only briefl y her experiences with various medications, Danquah foregrounds her personal struggles and the political contexts in which they take place. I would like to thank Jonathan Metzl for bringing Danquah’s relationship with Eli Lilly to my attention. 14. A 2001 Surgeon General’s report on these disparities indicates that “racial and ethnic minorities” in the U.S. receive “less care and poorer quality of care” than white people (“Mental”). And a 2000 study of the treatment of people already diag- nosed with depression—controlled for age, gender, health insurance status, and other factors—found a striking disparity: 44 percent of white patients and 27.8 percent of Black patients were given antidepressant medication (UT, 70). 15. Anne Wilson and Peter Beresford describe this double bind as an “increasing polarization of madness and distress into two categories—of the ‘threateningly mad’ and the ‘worried well’” (153). Refl ecting psychiatry’s distinction between “psychoses” and “neuroses,” these categories “serve both to dismiss and to devalue the experience and distress of those of us not seen as ‘ill’ enough to require public resources for support, and to reinforce assumptions about a discrete and separate group of mad people that constitutes a threat to the rest of society” (154; 153). 16. For discussions of the misperception of depression as an illness aff ecting only white people, see Boyd (5–7) and Marano (2). 17. In Rhonda Collins’s documentary fi lm, We Don’t Live under Normal Conditions, people of various races and ethnicities discuss what it means to them to be depressed; most, but not all, see the origins of their distress as primarily social. Most of the depression memoirs published in the last decade in the United States are authored by white people, many of whom describe the benefi ts of antidepressants. See Styron, Wurtzel, Solomon, and Jamison. 18. See Unequal Treatment 611–21. Th ese discrepancies are well documented and alarming. For example, a 1993 study “found that 79 percent of African Americans in a public-sector hospital were diagnosed with schizophrenia, compared with 43 percent of whites” (613). In another study, “28 percent of African Americans in a university hospital emergency room were given such a diagnosis, compared with 20 percent of whites.” A 1996 study found that “African American patients seen in an emergency room received 50 percent higher doses of antipsychotic medications than patients of other ethnic groups, while their doctors devoted less time to assessing them” (613). In a 1998 study, researchers asked psychiatrists to provide diagnoses of patients based upon written case histories. Th e psychiatrists each reviewed identical case histories, but their diagnoses varied widely, depending on what they were told the patients’ race and gender were. Th e diagnosis of “paranoid schizophrenic disorder,” which, the authors of the study note, is associated with “violence, suspiciousness, and dangerousness,” was applied to patients believed to be Black men at a rate of 43 percent, compared with 6 percent for white men, 10 percent for white women, and 12 percent for Black women (615). 19. An awareness of the medical profession’s pathologizing attitudes toward Black people deters many African Americans from seeking health care, especially for symptoms of mental illness. Psychological studies in reputable journals in the 1950s compared average Africans to “the white mental patient,” “the lobotomized West European,” and the “traditional psychopath” (L.R.C. Haward and W.A. Roland, “Some inter-cultural diff erences on the Draw-A-Person Test: Part I, Goodenough scores,” Man 54 [1954], p. 87, qtd. in Bulhan, 83–84; J.C. Carothers, “Th e African mind in health and dis- ease,” Geneva, World Health Organization, 1953, qtd. in Bulhan, 84). Th e 1965 Moynihan Report claimed that African American families were disintegrating because of their putatively “matriarchal” structure (Boyd, “Ethnic,” 230). In the 1960s and 1970s, respected neurosurgeons and psychiatrists publishing in venues such as the Journal of the American Medical Association advocated psychosurgery to treat the “brain disease” they claimed caused “riots and urban violence” (Breggin, WA, 117). In the early 1990s, Frederick Goodwin, the chief scientist at the National Institute of Mental Health, proposed a “violence initiative,” which would identify among “inner-city” adolescents—whom Goodwin compared to monkeys in a jungle—those with a genetic predisposition to violence and then subject them to psychiatric interventions (Breggin, WA 8). 20. See Barnes and Mercer (IS, 2) and Oliver (PD, 11). Although the social model’s authors intended it to serve primarily as a “heuristic device,” rather than a comprehensive theory of disability, its distinction between impairment and disability remains fundamental to disability scholarship in both the UK and the United States (Barnes and Mercer, IS, 3). 21. Th
e concluding chapter of Garland-Th omson’s Extraordinary Bodies calls for a shift in understanding disability, “From Pathology to Identity.” Steven Taylor argues that “a Disability Studies perspective questions the medical model and challenges” the equation of disability with “sickness and pathology” (“Guidelines,” 4). Steven E. Brown states that “a person with a disability is not sick” (11). Barnes and Mercer criticize representations of people with disabilities as “sick” or “suff ering” (Disability, 9; 10). And Simon Brisenden urges a diff erentiation “between a disability and a disease” (25). Asserting that “disability is not illness,” Anita Silvers acknowledges that chronic illnesses can be disabling but insists that “persons with paradigmatic disabilities—paraplegia, blindness, deafness, and others” must be distinguished from “people suff ering from illness” (77). David Pfeiff er also emphasizes that “disability is not sickness” and claims that “for a half to three quarters of the disability community there is no present sickness which disables them” (6). Pfeiff er doesn’t make RT3340X_C023.indd 295 RT3340X_C023.indd 295 7/11/2006 10:09:03 AM 7/11/2006 10:09:03 AM Anna Mollow 296
clear, in his estimate of the statistical prevalence of illness among people with disabilities, how he defi nes the “disability community.” 22. See Harlan Hahn, Th e Issue of Equality: European Perceptions of Employment Policy for Disabled Persons [New York: World Rehabilitation Fund, 1984], 14, qtd. in Hahn, “Advertising,” 175. 23. Th
is is not to suggest that suff ering is the most important aspect of depression for everyone who experiences it. Jane Phillips describes her depression as a “dark and dangerous illness,” but also as an experience that “seemed to serve a function,” facilitating her emergence “into an utterly new spring” (140–41). I am grateful to Richard Ingram for bringing this passage to my attention. 24. Deconstructions of the social model share similarities with “universalizing” approaches to disability in the United States, which, rather than conceiving of people with disabilities as members of a distinct minority group, instead highlight the fl uidity of disability as an identity category and describe bodily diff erence as existing on a continuum of human varia- tion.
25. Danquah’s assertion is tautological (illnesses, by defi nition, are conditions that “reach clinical proportions”); however, I am concerned here, not with establishing the “truth” or “falsity” of the claim that depression is an illness, but rather with delineating the tactical and strategic uses to which its construction as such is put. I would like to thank Richard Ingram for pointing out to me the tautological nature of Danquah’s statement. 26. In the eighteenth century the physical examination was regarded as so unimportant that doctors oft en practiced medicine by mail, relying on patients’ lengthy narratives to make diagnoses (Reiser, 5–6). 27. For detailed accounts of the history of clinical medicine, see Foucault (BC), Ackernecht, and Jewson. 28. Th
ere are exceptions to this trend, most of which are also invisible disabilities: “mental illnesses”; some cognitive dis- abilities; and physical conditions such as chronic fatigue syndrome, repetitive strain injury, Environmental Illness, and fi bromyalgia, which don’t produce objectively observable bodily changes. But most of these conditions, like depression, are “controversial”; they will be defi ned as “syndromes” rather than actual “diseases” until they can be correlated with measurable physiological abnormalities. 29. Disorders such as these illustrate the impossibility of any absolute binary between “visible” and “invisible” disabilities. Th ese conditions may oft en be invisible to the casual observer, but their signs can be seen on medical tests. Notwithstanding medical technologies that rely on senses other than sight, the visual bias of modern medical epistemology is pronounced; it can be discerned even the word “stethoscope,” which combines the Greek words for “chest” and “I view” (Reiser, 25). 30. Nonverbal people with disabilities can also be diagnosed with depression, but the formation of depression as an impair- ment category has depended in large part upon patients’ verbal articulations of their distress. 31. I would like to thank Richard Ingram for pointing this out to me. 32. My comparison between Danquah’s political strategy and that of the nineteenth-century “homosexual” Foucault describes illustrates the limits of analogies between diff erent subject positions. Despite the similarities I will discuss, Danquah’s desire to be cured contrasts with the nineteenth-century “homosexual”’s demands to be accepted as such. I would like to thank Sue Schweik for pointing this diff erence out to me. 33. For example, see “Cognitive” (3). 34. While I share Tremain’s sense that it is “politically naïve to suggest that the term ‘impairment’ is value-neutral,” I none- theless hope to show that it is possible to cite impairment categories without merely reinforcing normalizing discourses (SI, 34). 35. Th
is characterization is consistent with the overall thrust of Tremain’s argument. In “On the Subject of Impairment” (2002), Tremain touches briefl y on Foucault’s concept of discursive reversibility, noting that the “disciplinary apparatus of the state . . . brings into discourse the very conditions for subverting that apparatus” (44). She maintains, however, that by “articulating our lived experiences” in ways that “continue to animate the regulatory fi ctions of ‘impairment,’” disabled people risk merely augmenting normalizing and homogenizing social processes (44; 45). Similarly, in one paragraph of her introduction to Foucault and the Government of Disability (2005), Tremain notes Foucault’s interest in the “strategic reversibility” engendered by hegemonic discourses but nonetheless reiterates the central claims of her earlier essay. 36. I strongly concur with Tremain’s argument for a disability theory that will “expose the disciplinary character of . . . identity,” rather than “ground[ing] its claims to entitlement in that identity” (SI, 44; FG, 10). In fact, Tremain’s criticisms of identity- based movements parallel arguments I make in my essay, “Disability Studies and Identity Politics: A Critique of Recent Th eory.” I share Tremain’s view that identity politics risks reifying identity categories that might better be contested, is almost inevitably exclusionary and productive of hierarchies, and impedes alliances with other political minorities. Indeed, I am trying to make these problems apparent in my discussion of the ways in which entrenched ideas within disability studies exclude experiences such as Danquah describes in her memoir. But I am also attempting to demonstrate that Danquah utilizes her self-defi nition as a “depressive” in ways that do not replicate these dynamics of identity politics movements (18). 37. Th
is discrepancy again exemplifi es the limitations of analogies between diff erent forms of oppression. Butler asks, “When and how does a term like ‘queer’ become subject to an affi rmative resignifi cation for some when a term like ‘nigger,’ despite some recent eff orts at reclamation, appears capable of only reinscribing its pain?” (223). For Danquah, such reinscription is also the inevitable eff ect of hearing this word repeated. She remembers the fi rst time she was called a ‘nigger’ to her face, by a high school boy she had asked to dance: “Even now when I hear that word—nigger—whether it is spoken by a black person or a white person, it is the simple tone and disgust of that boy’s voice that I hear” (43). RT3340X_C023.indd 296 RT3340X_C023.indd 296 7/11/2006 10:09:04 AM 7/11/2006 10:09:04 AM
297 “When Black Women Start Going on Prozac . . .” 38. Boyd also observes that it can be diffi cult to reconcile “beliefs about being strong Black women” with “having an illness that we’ve long associated with weakness of the lowest kind” (CI, 5). Similarly, Angela Mitchell observes that “one reason Black women don’t get treated for depression is that we oft en expect to feel sad, tired, and unable to think straight” (47). She reminds her readers that “Black women do not have to be depressed. It is not our lot in life” (47). Th e perception that depression is a form of weakness that Black women cannot “aff ord” is addressed on numerous web sites about Black women and depression (Marano, 2). See Rouse, 6. 39. Mitchell also connects the “mammy stereotype,” which is “rooted in the history of slavery,” to Black women’s depression, arguing that this stereotype creates an imperative for Black women to prioritize other others’ needs over their own (53; 56). 40. Similarly, bell hooks has asserted that “to be strong in the face of oppression is not the same as overcoming oppres- sion . . . endurance is not be confused with transformation” (qtd. in Mitchell, 69). Mitchell makes this point as well: Black women’s endurance of “suff ering and hardship,” she argues, should not be confused with “strength” (69). 41. Wilson and Beresford describe the damaging repercussions of constructions of mental illness that “leave the holder of the diagnosis feeling utterly hopeless” and create a social expectation that those who have been diagnosed with mental illness “can never fully recover” (150). In addition, numerous African American feminists, activists, and critical race theorists have argued for the importance of hope and optimism, on both an individual and a collective level. Alex Mer- cedes, an African American woman who is a subject of Collins’s documentary, argues that “it’s important to focus on the individual . . . because the revolution will not happen overnight . . . so in the meantime, I, as an individual, must walk through this sexist, patriarchal hell.” Harris criticizes white feminism for its focus on “victimization and misery” and insists upon women’s ability to “shape their own lives” (613). Warning against the danger of a “capitulation to a sense of inevitable doom,” Patricia Williams expresses an “optimistic conviction” of the possibility of both “institutional power to make change” and “the individual will to change” (64; 65; 68). And in the introduction to Th e Black Women’s Health Book, White is hopeful about Black women’s power to “address and overcome the numerous issues that have damaged” their health, in part through individual “resilience and stalwart determination” (xiv; xvi). Works Cited Ackernecht, Erwin M. Medicine at the Paris Hospital 1794–1848. Baltimore: Johns Hopkins University Press, 1976. Barnes, Colin, and Geof Mercer, eds. Implementing the Social Model of Disability: Th eory and Research. Leeds, UK: Th e Dis- ability Press, 2004. Cited within the text as IS. ———. Disability. Cambridge, UK: Blackwell, 2003. Boyd, Julia A. Can I Get a Witness?: Black Women and Depression. New York: Penguin, 1999. Cited within the text as CI. ———. “Ethnic and Cultural Diversity in Feminist Th erapy: Keys to Power.” In Th e Black Women’s Health Book: Speaking for Ourselves, edited by Evelyn C. White, 226–34. Seattle, Washington: Seal Press, 1990. Cited within the text as “Ethnic.” Breggin, Peter R., M.D. Toxic Psychiatry: Why Th erapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biochemical Th eories of the “New Psychiatry.” New York: St. Martin’s Press, 1991. Cited within the text as TP. Breggin, Peter R., M.D., and Ginger Ross Breggin. Th e War against Children. New York: St. Martin’s Press, 1994. Cited within the text as WA. Brisenden, Simon. “Independent Living and the Medical Model.” In Th e Disability Reader: Social Science Perspectives, edited by Tom Shakespeare, 20–7. London and New York: Cassell, 1998. Brown, Steven. “Freedom of Movement: Independent Living History and Philosophy.” Independent Living Research Utilization. Available online at http://www.ilru.org/html/publications/bookshelf/freedom_movement.html (1–20). Bulhan, Hussein Abdilahi. Frantz Fanon and the Psychology of Oppression. New York and London: Plenum Press, 1985. Clare, Eli. Exile and Pride: Disability, Queerness, and Liberation. Cambridge, Massachusetts: South End Press, 1999. Collins, Rhonda, dir. We Don’t Live under Normal Conditions. Videocassette. Boston, Massachusetts: Fanlight Productions, 2000.
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